Imaging predictors of remission to anti-depressant medications in major depressive disorder

Kee F Chi; Mayuresh Korgaonkar; Stuart M Grieve

doi:10.1016/j.jad.2015.07.002

Imaging predictors of remission to anti-depressant medications in major depressive disorder

J Affect Disord. 2015 Nov 1;186:134-44. doi: 10.1016/j.jad.2015.07.002. Epub 2015 Jul 21.

Authors

Kee F Chi¹, Mayuresh Korgaonkar², Stuart M Grieve³

Affiliations

¹ Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2006, Australia; Sydney Translational Imaging Laboratory, Charles Perkins Centre and Sydney Medical School, University of Sydney, NSW 2006, Australia.
² The Brain Dynamics Centre, Westmead Millennium Institute and Sydney Medical School, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Westmead Hospital, Sydney, NSW, Australia.
³ Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2006, Australia; Sydney Translational Imaging Laboratory, Charles Perkins Centre and Sydney Medical School, University of Sydney, NSW 2006, Australia; The Brain Dynamics Centre, Westmead Millennium Institute and Sydney Medical School, Sydney, NSW, Australia. Electronic address: stuart.grieve@sydney.edu.au.

PMID: 26233324
DOI: 10.1016/j.jad.2015.07.002

Abstract

Background: We review what is currently known about neuroimaging predictors of remission in major depressive disorder (MDD) after antidepressant medication (ADM) treatment.

Methods: A systematic literature search found a total of twenty-seven studies comparing baseline neuroimaging findings in depressed patients who achieved remission with non-remitters following treatment with ADMs.

Results: Eighteen of these studies utilised structural magnetic resonance imaging (MRI). These studies associated larger hippocampal (four studies) and cingulate volume (two studies) with remission. Two diffusion MRI studies identified a positive relationship between the fractional anisotropy of the cingulum bundle and remission. White matter signal hyperintensities were quantified in two papers - both observing decreased remission rates with increasing lesion burden. Nine studies on functional imaging met inclusion criteria - three using functional MRI, one with single photon emission computed tomography (SPECT), and five which evaluated patients with positron emission tomography (PET). These findings were not convergent, with different regions of interest interrogated.

Limitations: The studies were generally underpowered. Overall these data were heterogeneous with only a small number identifying concordant findings.

Conclusions: At present, the data remains inconsistent. The more promising biomarker of remission to ADMs appears to be hippocampal size, although this marker also has conflicting reports. Given remission should be the primary end-point of treatment, and that ADMs are the front-line treatment type for MDD, more focussed research is required to focus specifically on the imaging correlates of remission to ADMs.

Keywords: Antidepressant medications; Major depressive disorder; Neuroimaging; Remission.

Publication types

Review

MeSH terms

Anisotropy
Antidepressive Agents / therapeutic use*
Brain / pathology*
Brain / physiopathology*
Depressive Disorder, Major / drug therapy*
Depressive Disorder, Major / pathology*
Depressive Disorder, Major / physiopathology*
Diffusion Magnetic Resonance Imaging
Endophenotypes
Female
Gray Matter / pathology
Humans
Hypertrophy / pathology
Magnetic Resonance Imaging
Neuroimaging
Positron-Emission Tomography
Remission Induction / methods
Tomography, Emission-Computed, Single-Photon
White Matter / pathology

Substances

Antidepressive Agents